Case Selection for Apical Surgery: A Retrospective Evaluation of Associated Factors and Rational

Abstract

Endodontic failures associated with poor quality of endodontics respond favorably to retreatment. Nevertheless, under certain clinical conditions, apicoectomy should be the preferred procedure. A retrospective survey of 200 roots that were referred for apical surgery revealed that 83% of the roots were inadequately obturated, including 8.5% with no root canal filling at all. In 49 of the roots in this group (24.5% of the referred cases) nonsurgical retreatment was judged by an endodontist as either impossible or improbable because it might jeopardize the root integrity. Retreatment should have been the preferred treatment modality for the rest of the group, provided that coronal restorations could be safely bypassed or removed. Posts were found in 63 of these teeth, however 35 of them were either short or loosely fitting and could safely be removed. The rest of the posts were longer than 5 mm, which might have presented a problem if their removal was attempted. In 45% of the 200 cases in the present study, surgical intervention was justified. The rest of the cases (55%) should have either been subjected to a follow-up (10.5%) or retreated nonsurgically by a skilled endodontist (44.5%). These results indicate that referring dentists may not appreciate the retreatment possibilities offered by modern endodontics, and they emphasize the need for a shift of concept: endodontists should be involved in the decision making before referring a patient to surgery.

Treatment of endodontically induced periapical lesions using hydroxyapatite, platelet-rich plasma, and a combination of both: An in vivo study

“…They have reported that treatment of 24.5% of the cases was impossible without surgical therapy. [3]…”

Nonsurgical management of an extensive endodontic lesion in an orthodontic patient by calcium-enriched mixture apical plug

“…[172122] In other words, the majority of apical lesions whether cysts or granuloma heal without surgery; only those few lesions that may be true cysts in histology need surgery. [5] Nonsurgical approach in cases of AP is the first treatment option, based on the current concept of treatment decision making;[23] and in case of persistent symptoms the surgical removal of the lesion is considered as the next step. [192022] The treatment outcome for this patient, confirms this statement that although the lesion responded favorably to nonsurgical treatment, the possibility for surgical intervention was kept in mind in case it did not.…”

Current strategy for successful periradicular surgery

“…failure, and the root canal is coronally accessible and negotiable, surgical treatment is not considered the treatment of choice (8). The success rate for periradicular surgery is lower than that of root canal retreatment.…”